The Journal of cardiovascular nursing
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Post-acute care (PAC) is available for older adults who need additional services after hospitalization for acute cardiac events. With the aging population and an increase in the prevalence of cardiac disease, it is important to determine current PAC use for cardiac patients to assist health care workers to meet the needs of older cardiac patients. The purpose of this study was to determine the current PAC use and factors associated with PAC use for older adults following hospitalization for a cardiac event that includes coronary artery bypass graft and valve surgeries, myocardial infarction (MI), percutaneous coronary intervention (PCI), and heart failure (HF). ⋯ The current rate of PAC use indicates that almost half of nondisabled Medicare patients discharged from the hospital following a cardiac event use one of these services. Health care professionals can increase PAC use for Asians, Hispanics, and Native Americans by including culturally targeted communication. Optimizing recovery for cardiac patients who use PAC may require focused cardiac rehabilitation strategies.
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The aim of this small-scale study was to explore the use of cluster analysis to identify subgroups of heart failure patients whose patterns of symptoms may help guide clinical management. The empirically derived clusters were compared on (1) demographics, (2) clinical characteristics, and (3) subscales of the Kansas City Cardiomyopathy Questionnaire. ⋯ Of 139 respondents, 33 (24%) were female and 106 (76%) were male. The mean (SD) age was 70.6 (9.7) years, and all were white, except for a single African American female. Most subjects were married (84%) with a median level of high school education, and 5% were New York Heart Association classification I, 38% class II, 52% class III, and 5% class IV. Hierarchical cluster analysis was used to derive a 3-cluster solution based on the presence or absence of 14 symptoms. Cluster 1 patients had significantly lower incidence of symptoms and were more likely to be New York Heart Association class I or class II, with lower body mass index and higher education levels compared with patients in the other clusters. Both clusters 2 and 3 were more symptomatic than cluster 1. Compared with cluster 3, patients in cluster 2 reported more shortness of breath under circumstances other than activity, and the majority reported difficulty sleeping. They also tended to report greater symptom severity and impact on physical activity and enjoyment of life. Additional differences included comorbidities and percentage of subjects on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Examination of the clusters suggested clinical implications related to pharmacological management and raised questions concerning potential influences of duration of the heart failure condition, presence of sleep-disordered breathing, and impact of educational level on self-management behavior and symptom patterns.
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Comparative Study
Symptom clusters in men and women with heart failure and their impact on cardiac event-free survival.
Because patients with heart failure (HF) experience multiple symptoms simultaneously, it is necessary to explore symptom clusters rather than individual symptoms to determine their impact on outcomes. Given gender differences in symptom experience, examination of potential gender differences in clusters is reasonable. ⋯ Although distress for individual symptoms may differ between men and women, they both experienced identical symptom clusters. Only the emotional/cognitive cluster predicted a higher risk for a cardiac event. These results suggested that interventions should be developed that consider symptom clusters. Targeting patients who have high distress from emotional/cognitive symptoms may be particularly important as they may be most vulnerable for adverse outcomes.
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The purpose of this secondary analysis was to profile or cluster 226 patients, who had participated in a randomized controlled trial, on symptoms after coronary artery bypass surgery and to examine how these profiles could potentially be used by clinicians to identify groups at risk for impaired functioning during the first 6 months after surgery. Variables measured were symptom presence and burden and functioning. The model-based clustering method was used for cluster analysis of the symptom burden measure, and analyses of covariance were used to determine if there were differences on functioning (physical functioning and physical activity) by symptom burden group at 6 weeks and at 3 and 6 months after dismissal. ⋯ However, there were significant main effects (P < .01) for symptom burden groups for physical functioning (physical and vitality functioning) and physical activity (estimated energy expenditure and mean daily total activity counts). Significant main effects for time indicated physical functioning and physical activity measures, except bodily pain, improved over time (P < .05). Study results indicate that the use of profiling coronary artery bypass surgery patients on their symptoms prior to hospital discharge may assist health care providers to identify patients who could be at risk for having more difficulty with physical functioning and physical activity during the first 6 months after surgery.